Treatment of behavioral and psychiatric problems associated with opiate dependence

Many difficult and complex behavioral and psychiatric problems can occur in a methadone treatment program. Some behavioral problems are very serious, and it is essential that the program place a high priority on controlling them. This is best done by structuring the treatment milieu via program rules. Careful attention must be paid to consistent, fair, and accurate enforcement of these rules. A proper staffing pattern is essential; this should include counselors along with medical, administrative, and pharmacy personnel, and police. Written policies explaining clinic procedures such as treatment plans, use of ancillary medications, and take-home policies are most helpful. They provide structure for the staff and increase the chances that work will be done in an organized and consistent manner. The physical facility may have features which either enhance or interfere with treatment and must be taken into account when planning. Attention should be paid to accurate diagnosis and treatment of the patients' psychiatric, behavioral, and social problems, and staff morale must be maintained. The best general ingredients for good patient management appear to be a combination of structure and support, applied in a systematic and coordinated way by a well-trained staff. Finally, integration of research and clinical efforts may present unique problems but has considerable benefit in most programs.